For many years I have been surprising new patients by not initially examining their teeth but by questioning them about their general health. I then examine oral facial muscles and the Temporal Mandibular Joint (TMJ), for which I use a stethoscope to hear whether it makes noises such as clicking or scratching.
Surprisingly, in many patients over 30, I find pressure sensitivity or painful muscles and pathological changes of the TMJ. This often gives patients not only headaches but also earaches and tinnitus. Many patients say they have not been able to cure the suffering caused by these painful symptoms.
When questioning patients about certain habits, such as grinding their teeth, pressing them together or pressing the tongue or lips, I find that about 80 per cent do these parafunctions subconsciously, resulting in pain in the muscles and joints, especially in the morning when they wake up.
After a night performing these parafunctions, rather than feeling refreshed, a patient may wake up with a headache or the feeling of a band around his head. Occasionally, patients may find difficulty opening their mouth as the joints are stiff.
This is often affiliated with noise in the ears (tinnitus), nausea or an earache. When patients suffering these symptoms seek advice from an ear specialist, they very often get the frustrating answer that there is nothing wrong with them. Some ear specialists know about this problem and subsequently send the patient to a dentist as we can deal with this circle of symptoms.
I have even had patients in whom I found such symptoms when conducting a routine examination. When I tell them they are suffering from what is called myofascial syndrome and arthritis of the TMJ, which causes earache, tinnitus and nausea, some tell me they had visited an ear specialist only to be called hypochondriacs, as there was nothing wrong with their ears.
The reason for these parafunctions can often be found in disturbances in the patients’ psycho social environment. Other causes could be uneven teeth, which forces the person to chew on one side, or badly-fitted crowns or fillings, resulting in grinding to fit better with the rest of the teeth.
Many patients perform these parafuctions for years and experience no such symptoms; but then something happens, for example, they may have a tooth filled or a crown inserted, or they may experience problems at work, in the family or elsewhere, and the pain begins.
The cure can be very easy. In many cases, patients are happy when they wear a splint during the night.
This article was previously published in the Rheinische Post in Germany. For further information e-mail the author at info@apollonia-dental-gozo.com or visit www.apollonia-dental-gozo.com.
Dr Buddenberg is a dentist based in Gozo.